In the previous two articles of this series, we discussed the trends and products of dermal fillers. In this article, we will take a look at side effects that may arise with filler procedures.

All kinds of scary stories abound on the internet about side effects of fillers. Many of my patients also have ungrounded fears about fillers.

The most common complaint found on the internet is that the injection site is bumpy and asymmetrical. Some say lumps can be felt. There is a story about the filler substance migrating downward or the injection site turning transparent. Permanent fillers, in particular, have bad reputations. They are rumored to contain carcinogens or decompose in the human body, etc. Some patients argue that news programs report fillers contain carcinogens and I deny the facts when I explain that is not true. Some patients who have received permanent filler injections hear such rumors and come back to my practice very emotional and worried.  

To eradicate unverified claims about the safety of fillers, it is necessary to educate correct information. This is why I thought a series dedicated to side effects of injectable dermal fillers was needed.

 

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Doctor-related side effects vs. Product-related side effects

 

Side effects largely arise from improper injection techniques or the low quality of the filler product. A wrong choice of the filler by an inexperienced doctor may also lead to side effects. One such mistake is injecting a hard filler in the lips. Even if the injection was carried out flawlessly, the undesired outcome of hardened lips would be a major problem. When extensive surfaces are injected with permanent fillers, most doctors advise the patient to massage the treatment area. This is because the round protrusion can be flattened. However, hard or permanent fillers do not spread evenly and may become bumpy after massaging. Failure to choose the correct filler type for the treatment area – such as using a hard filler in shallow depths or using soft fillers in the nose – stems from lack of knowledge about dermal fillers. In the early days, only soft fillers were available and many doctors including myself chose the wrong product for the treatment area.  

Let’s categorize possible side effects related to dermal fillers.

 

Unrealistic Expectation

 

Medically caused side effects can be resolved with further treatment or correction, etc. However, side effects with psychological causes are more difficult. Patients with unrealistic expectations are frequently mentioned in foreign literature as well and are particularly difficult to satisfy. I use photograph images of before and after treatment, however, patients with this type of complaint are not easily persuaded.

 

Migration of the filler

 

Migration of filler materials causes a big problem. In some cases, the filler injected in the nose migrates all the way down to the lips. Patients sometimes touch the injected filler and move it or some products tend to rise close to the skin surface. Migration most commonly occurs in the nose area. Patients often pinch the filler material upward or downward. When patients come back with a drastically disfigured shape of the injected filler, it is quite obvious that they touched the injection site. However, patients never admit to touching the treatment site. I still puzzles me but female patients tend to touch their nose more after treatment.

It is rare for the filler to migrate on its own without patients touching the treatment site. The most common cause of filler migration is the patient pinching and touching the injection site. It is important to advise the patient to not touch the treated area. As fillers are in a liquid form, touching it repeatedly will easily move it out of its original position. Patients must be instructed of the importance of preserving the treatment area.

 

Allergy

 

I experienced one case of allergic reaction in 2005. The filler was injected into the side of the nose bridge and it migrated toward the eye and caused a large swelling along its path. Fortunately, medication and injection helped resolve this reaction quickly.

 

Skin Marks

Skin marks appear when fillers are injected too close to the skin surface. Just as leather bags stretch downward when carrying heavy objects, excessive pressure given during injection right under the skin surface may cause undesired marks on the skin. This may be the biggest problem with superficial injection. In some cases, the skin turns transparent under the injection site.

Skin marks and rupture of filler materials under pressure constitutes an emergency. When an injected filler is under pressure and is left unattended, it may rupture and cause scarring. Quick removal can help regeneration but patients sometimes do not seek the doctor until it is too late.  

Skin marks are common with inexperienced doctors. As they are less confident about performing deeper injections, they make shallow injections due to fear of what is underneath the skin. However, they do not know that shallow injections are risky as all major blood vessels lie immediately under the skin surface. Doctors carrying out dermal filler injections must have sufficient anatomical knowledge.

 

-To be  continued-